Provider Demographics
NPI:1871581116
Name:HINTZE, BRET J (DPM)
Entity type:Individual
Prefix:DR
First Name:BRET
Middle Name:J
Last Name:HINTZE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 GORDON ROAD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:JASPER
Mailing Address - State:GA
Mailing Address - Zip Code:30143-1017
Mailing Address - Country:US
Mailing Address - Phone:770-999-0804
Mailing Address - Fax:770-999-0814
Practice Address - Street 1:49 GORDON ROAD
Practice Address - Street 2:SUITE 104
Practice Address - City:JASPER
Practice Address - State:GA
Practice Address - Zip Code:30143-1017
Practice Address - Country:US
Practice Address - Phone:770-999-0804
Practice Address - Fax:770-999-0814
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2018-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPOD000925213ES0131X, 213E00000X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000904945OMedicaid
GA000904945KMedicaid
GA000904945LMedicaid
GA000904945MMedicaid
GA000904945PMedicaid
GA000904945PMedicaid
GA000904945LMedicaid
GA48SCCWDMedicare PIN